What is inflammation of the quadriceps insertion?

The insertion of a muscle is the point where it attaches to the bone. The quadriceps muscles insert at the top of the kneecap. Over use can cause the tendon where they insert to become inflamed.

What are the symptoms?

                   Pain during and after exercise. If you contract your quads with your leg straight you might also get pain.

                   Pain can also be felt when pressing in along the top of the kneecap.

                   Stiffness the day after training can also occur.

                   Pain when standing from a crouched position

Treatment

                   Apply R.I.C.E. (Rest, Ice, Compress, Elevate).

                   Apply heat and use a heat retainer.

                   Stretch the quadriceps muscles.

                   Get Sports Massage treatment

Stretching the quadriceps is a very important part of rehabilitation of this injury and must not be neglected. Rest is unfortunately also important. If you do not rest, it will not get better!

                  

 

 

Cold Therapy

                   Cold therapy can be applied in a number of ways with different products but the principles remain the same. Cold is not put into the body but heat is taken out. So anything that is colder than the body tissues will cause heat to be removed from the body.

                   If using ice, it should never be applied directly to the skin but in a wet tea towel to prevent ice burns.

                   Apply the ice for about 15 minutes every 2 hours. This will vary depending on the size of the area and depth of the tissue. This can be reduced gradually over the next 24 hours.

                   If you have a bad circulation condition in a specific area then you should not apply ice to that area, or if you have a cold allergy.

Reducing pain and inflammation

                   Rest. This may mean simply modifying the type of training done for a less severe injury for example avoiding explosive jumping or plyometric activities.

                   For injuries that cause pain during training then a complete period of rest may be required.

                   If the injury is chronic then a sustained period of rest may be required. For more acute injuries a rest period of 2 to 4 weeks may be sufficient.

                   In the acute stage, if there is pain on movement of the knee joint, usually the first 2 to 4 days, apply ice or cold therapy (not directly to the skin).

                   After the acute stage, apply heat and wear a heat retainer

Improving muscle and tendon condition.

                   It is not enough simply to be pain free. The tendon must be restored as closely as possible to it's original condition. The muscles must also be stretched and restored to optimum condition if re-injury is to be avoided.

                   Stretching the quadriceps muscles is very important to the recovery of this injury. Stretch at least 3 times a day and continue to stretch long after the injury has healed.

                   Stretching can begin as soon as it can be done pain free - usually from day 1.

                   Sports massage techniques can also play a key role in the rehabilitation of this injury. Cross friction massage to the site of pain can improve tendon function. Sports massage applied to the quadriceps muscles will help them stretch more easily, placing less stress on the tendon insertions.  

 

Stretching & Strengthening exercises

                   These can be done as soon as they can be performed pain free and without causing delayed symptoms such as pain afterwards or the next day. This may be between 2 and 7 days following injury, depending on severity. It may be longer.

                   Begin with static contractions and when these can be performed comfortably, progress onto dynamic leg extension and squat exercises. ( See Below)

                   More advanced plyometric exercises should be performed later in the rehabilitation plan and prior to returning to competition.

                   Strengthening exercises can be performed on a daily basis initially (usually for the first week or two), especially with the static contraction exercises. As intensity progresses with the dynamic exercises, the athlete may require a rest day in between sessions to allow the muscles to fully recover.

Return to full fitness

                   The length of time that is required to return to full fitness will depend on the severity of the injury and whether or not it is a recurrent injury or a first time injury. For a first time injury, recovery may take 2 to 3 months. A longer term chronic, recurring injury may need 4 to 6 months.

                   Gradually return to sports specific training. Again depending on severity this may be days, it may be weeks. Pain should be the guide.

                   Begin with gentle jogging. When the athlete can jog 20 minutes without pain during or after then progress to running and sprinting.

                   An example of a speed session might be 10x50m sprints at 50% effort. Next session perform 10x50m at 75% of full speed and so on.

                   Continue to stretch and perform specific strengthening exercises throughout this phase of rehabilitation.

I am really having trouble shaking this injury off!

                   Rigorously stretch the muscles at least 3 times a day.

                   Cross friction massage to the tendon at the site of pain can be applied on a daily basis. This has proved valuable in recovery of even chronic cases.

                   If the injury does not respond to rehabilitation then seek further professional advice as surgery may be required.

Stretching (Quadriceps muscles) The muscles in particular that need to be stretched are the Quadriceps group at the front of the thigh. These are made up of Vastus lateralis, Vastus medialis, Vastus intermedius which start (originate) at the thigh and insert into the Tibia (shin bone) via the kneecap, as well as the Rectus femoris. The Rectus femoris starts at the front of the hip and also inserts via the kneecap. Testing flexibility This can be tested by performing Thompson's test. Lie on your back as shown in the image opposite. Pull one knee up as high as it will go. The thigh of the free leg should be horizontal. If it rides up, this indicates possible tight hip flexor muscles (Rectus femoris or Iliopsoas). The shin of the free leg should hand vertically. If not then this may indicate tight Quadriceps muscles. Quad stretch 1 Hold the foot of the leg to be stretched and gently pull up behind. Aim to keep the knees together and pull the leg up straight not twisted. You should feel a stretch at the front of the leg. It should not be painful. In the early acute stages of treatment hold stretches for around 10 seconds. Later on when the inflammation has gone stretches should be held for around 30 seconds. Repeat 5 times and stretch at least 3 times a day. Quad stretch 2 Kneel on one knee with a very padded cushion for support. Pull the foot up behind as shown. This stretch will target the Rectus femoris more. If you have any pain on the knee when performing this stretch, avoid it. This stretch places a lot of pressure on the kneecap when kneeling down so it is essential to have plenty of padding for support.      Strengthening exercises Below

image 1 - Testing the flexibility of the hip flexors and quadriceps muscles. image 2 - image 3 - Quadricpes stretching on the knee

Strengthening (Quadriceps muscles and tendons) Strengthening exercises should begin as soon as pain will allow. If it hurts, don't do it. Also if you find you have more pain in the morning after doing strengthening exercises then you may need to reduce the workload. Static contractions These are simply performed by contacting the Quadriceps muscles at the front of the thigh whilst keeping the leg straight in the standing position. An example programme might be - contract for 10 seconds, relax for 3 seconds and do 10 repetitions. Rest for a minute and repeat up to five times. Although this exercise is boring it will maintain muscle bulk and ensure you are back to full fitness faster. Continue with this exercise on a daily basis until you are able to perform the eccentric exercises below. Double leg drop squats These are performed by moving slowly from a standing position to a squat position and back. The exercises can be progressed by increasing the range of movement the knee goes through and also the speed at which the exercises are done. The aim is to perform 3 sets of 10 repetitions at a speed that causes 'mild' pain in the tendon by the time you reach the last set. It is thought that these exercises stimulate healing far more than simply rest. It is essential that a full stretching sessions take place both before and after these strengthening exercises. The exercises can be performed three times a week.An example of progression might be to start with 3 sets of 10 repetitions at 30 degrees of movement per second progressing over a period of weeks to 3 sets at 30 degrees per second plus three sets at 50 degrees per second plus a further 3 sets at 70 degrees per second.

image 1 - Static quadriceps exercise image 2 - Squat